Effects of radiotherapy
on women

Radiotherapy treats cancer by using high-energy rays that destroy cancer cells. Radiotherapy to the pelvis can cause side effects that may affect your sex life and sexual function.

Pelvic radiotherapy may be used to treat cancers of the womb, cervix, anus, rectum and bladder. Radiotherapy to the pelvic area can cause the vagina to lose its stretchiness and it may become shorter or narrower. This can make vaginal penetration uncomfortable or difficult. Radiotherapy to the vulva may cause some swelling. Radiotherapy can also affect the anus and rectum which may affect your sex life if you have anal sex.

There are ways to help manage any changes so that you can still enjoy sex. And most of the side effects of radiotherapy are temporary. Your hospital team will be able to tell you more about what to expect and what can help.

If the ovaries are affected by radiotherapy, this may bring on the menopause if you have not already been through a natural menopause. You can talk to your nurse specialist about this and about how to manage symptoms.

Usually, there will be no medical reason to stop having sex during external radiotherapy. But, if you have unpleasant side effects from the treatment, you may lose interest in sex until you recover. If you have radiotherapy to the area between the hips (pelvis), or if you have internal radiotherapy, your doctor or specialist nurse can tell you if this will affect your sex life during treatment.

How cancer treatments may affect your sex life

Cancer and cancer treatments can affect your sexual function directly or indirectly. Direct effects can be caused by treatments that affect the sex organs or sex hormones. Indirect effects can be caused by side effects like tiredness, or by changes in a part of your body other than your sex organs.

It is important to remember that not everyone will have the side effects we mention. Your cancer doctor or nurse can answer any questions you may have about your treatment, and how it might affect you.

Pelvic radiotherapy

This type of radiotherapy may be used to treat cancers of the womb, cervix, anus, rectum and bladder. Radiotherapy to the pelvis may also be given as part of total body irradiation for some people having a stem cell transplant. Because it is given in the area close to the sex organs, pelvic radiotherapy may directly affect your sex life.

During treatment with pelvic radiotherapy, you might not feel interested in having sex due to side effects in the area. Skin in the treatment area often becomes red, and may be sore or itchy. The skin in the vagina, vulva, groin, perineum and anal areas is very sensitive. This can make sex difficult. You may also have bleeding from your vagina, bladder or rectum.

Pelvic radiotherapy can also cause side effects such as diarrhoea and feeling sick (nausea). Your bladder or rectum may be sore and may bleed. You may need to pass urine or bowel motions more often and more urgently than usual. Most of these side effects are temporary, but rarely some can be permanent. There are different ways you can cope with urinary and bowel changes.

Changes to the vagina

After treatment with pelvic radiotherapy, the vagina can lose its natural stretchiness. And it may become shorter and narrower. The vaginal walls may be scarred. This can make them stick together. The blood supply to the vagina may also be reduced, which can cause vaginal dryness. These changes to the vagina can make penetrative sex uncomfortable or difficult.

Your radiographer, specialist nurse or doctor may recommend treatments that can stop the walls of the vagina sticking together, and help maintain its stretchiness. There are also treatments that can help reduce vaginal dryness.

Changes to the vulva

The vulva is very sensitive to radiation. If you have radiotherapy to the vulva, you may get some swelling there. This may get better after a few months, but sometimes it can last for longer. The skin of the vulva may change in colour with radiotherapy. It may look redder or darker, depending on your original skin tone.

Changes to the ovaries

Pelvic radiotherapy affects the ovaries. It will bring on the menopause if you have not already had this. Early menopause may cause more noticeable symptoms than a natural menopause.

Changes to the anus and rectum

Pelvic radiotherapy can affect the anus and rectum. This can affect your sex life if you take part in anal sex or anal play as the receiving partner.

During radiotherapy, and for a few weeks afterwards, rectal pain may make anal penetration very uncomfortable or not possible. Side effects during treatment, such as diarrhoea or incontinence, may cause embarrassment and discomfort.

Radiotherapy treatment can cause long-term changes to the rectum. How much the rectum is affected depends on where the cancer was in the pelvis, and the type of radiotherapy you had. In some people, the rectum loses its stretchiness and can be injured more easily. Sometimes anal sex may no longer be possible. Your cancer doctor can tell you more about this.

After pelvic radiotherapy, if you want to have receptive anal sex you may need to start gradually before building up to full penetration. You may need to be more cautious than before. The anal and rectal tissues are more fragile and less able to heal after pelvic radiotherapy. It is important to prevent injury to your rectum, as it can be a very serious problem. You can speak to your doctor about whether it is safe for you to have receptive anal sex.

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